Surgical mesh material has several uses in surgery, such as positioning and immobilizing body organs or to support a body organ. Typically, the mesh is attached to body tissues at two or more locations by suturing or using surgical fasteners. For example, in inguinal hernia surgery, a polypropylene mesh is fastened to the abdominal wall in order to reinforce the abdominal wall. Insertion of mesh has also been used in the treatment of uterine prolapse, hernia, and urinary incontinence.
A variety of suturing devices as well as fastening devices are available for endoscopic or open procedures, to attach a strip or patch of mesh to a tissue. Many of these devices have a handle portion from which slender shaft extends that can be introduced into a body cavity with a small incision. At the distal end of the shaft are means for suturing or deploying a surgical fastener in a body tissue surface inside the cavity. In most of the surgical fastening devices, the shaft stores one or more surgical fasteners. An actuating mechanism contained in the handle portion ejects one or more fasteners from the distal end of the shaft. If the body tissue is accessible from two opposite sides, a fastening device may be used having an anvil that deforms the prongs of fastener after having passed through the body tissue. When the tissue is not accessible from two opposite sides, a fastening device not having an anvil is used. In one such fastening device, a fastener is screwed into the tissue. In another fastening device, disclosed in WO2009/022348, a fastener is used having a crown from which extend two or more prongs. The prong tips are retained in a baseplate. The fastener is deployed using a fastening device that moves the crown towards the baseplate. As the crown approaches the baseplate, the prongs splay radially outward as they penetrate the tissue.
In many applications, the surgeon manipulates the mesh into the desired position in the body using one hand, and then operates the suturing or fastening device with the other hand in order to affix the mesh to tissue surfaces. Manipulating the mesh and the fastening device in this way can be awkward. Thus, fastening devices are known in which a piece of mesh is retained on the tip of the shaft so that as a fastener is deployed the prongs pass through the mesh before entering the tissue.
For example, WO2009/022348 discloses providing the distal end of the shaft with one or more projections configured to engage a surgical mesh material and retain the mesh over the tip of the shaft. A piece of a surgical mesh material is engaged onto the projections at a first region of the mesh material. The distal end of the shaft with the surgical mesh material engaged on its tip is then delivered to a first location on a tissue surface. The actuating mechanism of the device is then actuated to eject a fastener from the distal end of the shaft into the tissue at the first location. As the fastener is ejected from the distal end of the shaft, the prongs of the fastener pass through the mesh so as to pin the mesh to the tissue at the first location.